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Background and objectivesThe goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.Subjects and MethodsTwo authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0–24 hours after leaving the operation room were included in the analysis.ResultsThe pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.ConclusionPreoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.

Postoperative pain and wound healing following tonsillectomy can result in dissatisfaction for the patient. However, there is no consensus on whether postoperatively administered honey effectively reduces morbidity after tonsillectomy. Therefore, a systematic review with a meta-analysis of the efficacy of honey as a treatment for postoperative pain and wound healing was performed. Two authors independently searched the database records (MEDLINE, SCOPUS, and Cochrane databases) dating from inception to June 2014. Studies comparing postoperative oral administration of honey with administration of placebo where the outcomes of interest were pain and wound healing on postoperative days were included. Baseline study characteristics, study quality, numbers of patients in steroid-treated and control groups, and treatment outcomes were extracted. Sufficient data for meta-analysis were retrieved from 4 trials with a total of 264 patients. We analyzed patient-reported pain scores and quantities of administered analgesics during the first 5 postoperative days. The pain score was significantly decreased in the honey-treated patients in comparison with the placebo-treated patients on postoperative day 1 only, but the analgesic intake of the honey-treated patients on the first 5 postoperative days was significantly less than that of the placebo-treated patients. In addition, honey significantly increased tonsillectomy bed wound healing in comparison with placebo during the first 2 weeks after surgery. This meta-analysis shows that postoperative administration of honey after tonsillectomy significantly reduces pain and promotes wound healing. Further trials comparing honey with good research methodology should be conducted to confirm these results.

NA. Laryngoscope, 126:608-615, 2016.